Program Report: FIRST
In the US, child abuse is a large problem that is difficult to solve because of the way that the laws and states are independently designed. Within this scope, child abuse is dealt with by a multitude of private and public programs that are linked typically through partnerships. At the federal level, entities exist for the purpose funding the most effective programs. The largerst of these is known as the Children’s Bureau:
The Children’s Bureau (CB) partners with federal, state, tribal and local agencies to improve the overall health and well-being of our nation’s children and families… In order to receive federal funding under title IV-B, a state or tribal agency requesting title IV-B funds must submit a 5-year Child and Family Services Plans (CFSP) and Annual Progress and Services Reports (APSRs). The CFSP is a strategic plan that sets forth a state’s or tribe’s vision and goals to strengthen its child welfare system (Children’s Bureau , 2017).
Within the goals of CB, there are many programs which become funded by the federal government through this approval process. One program is Arizona Families FIRST. The program goals are in line with the approval process for funding from the CB:
Arizona Families F.I.R.S.T. (Families in Recovery Succeeding Together- AFF) was established in 2000 as a partnership between the Department of Economic Security (DES) and the Department of Health Services (DHS). The AFF program helps parents address substance abuse issues that are affecting their ability to care appropriately for their children or to get and keep a job. It provides the opportunity for families to overcome the barrier of substance abuse in order to reach the outcomes of permanency for children, family reunification and self-sufficiency. The goal of the program is to reduce or eliminate abuse of and dependence on alcohol and other drugs and to address other adverse conditions related to substance abuse (FIRST, 2017).
This program’s mission is focused on of the primary goal of permanency for children, family reunification and self-sufficiency, in the substance abuser populations. The program is designed around these concepts and offers referral services for a range of issues including: outreach, assessment, treatment and recovery maintenance. In order to maintain eligibility for services, participants must adhere to random drug testing, in home screenings, and individual assessments for child welfare. These rules are designed to create compliance and to facilitate more stable environments for children who have suffered neglect or abuse within a substance abuse filled environment.
While the goals of FIRST are worthy and beneficial to many people, the problem with programs of this nature is that they are extremely limited and difficult to obtain. All of the work that FIRST does is performed through referrals. As such, a client that needs counseling, financial support, and housing could referred to three different agencies. Services from referred agencies are delivered with their own expectations and also on a first come first serve basis. It is in the delivery of services that many clients find themselves falling into a black hole.
Because services are delivered through a referral system there is little communication between the partnerships and often clients are referred to services and programs which are closed or at capacity. This creates a situation where the people who need these services are often unable to obtain them or become discouraged from trying. Exploited children provide a perfect example of this issue:
Libby Spears: Michelle’s mother prostituted her when Michelle was 5 years old, and there was a continuum of abuse throughout her entire childhood. Now she’s 19, and she just got out of jail. It was hard enough before when she was 5, and no one helped her in a way that was sustainable. Now she’s 19, and, as an adult, there’s really nothing for her. Michelle’s life is not just a pattern, but a continuum, of never getting a break, not having an opportunity to get out. All the things she needs she’s never gotten—a mentor, a job, emotional support, and therapy for what happened to her (Kalergis, 2009).
At every turn in the case of Libby Spears, service were unattainable or not available due to capacity. The example of Spears reflects a large issue within the system of how the referral system and funding creates systematic issues with allocating resources. This is understandable considering the fact that the resources are often limited by their scope and ability to provide help for children. Counseling for children of abuse is one of the primary intervention strategies but this often goes underserved because of the availability of services (Kalergis, 2009). Subsstance abuse intervention strategies are often limited to programs that are community based such as AA or NA and these have extremely limited effectiveness (Vaillant, 1995).
The larger more complex problem may reside in the program evaluation process. Program evaluation for FIRST is performed by CB which has a standard set of criteria that it looks for in program effectiveness. In order to obtain funding from CB, FIRST must submit a program evaluation that is performed by a third party which is hired by FIRST. Arizona university provides this evaluation and it is based on timeliness, availability, and accessibility of services. The numbers are revealing when one looks at them from the point of efficiency:
- Nearly all referrals to the AFF program (94.8%) received at least one recorded outreach attempt, and 43% of the referred individuals accepted services.
- Providers outreached to referred individuals in less than one day after receipt of the referral (0.6 business days).
- The reported rate of referred clients formally accepting AFF services dropped significantly, from 64% in SFY 2013 to 45.5% in SFY 2014.
- On average, AFF services were initiated a just over two weeks (17.2 days) from initial referral1.
- The total number of unique individuals that engaged in services during SFY 2014 was 5,464(ASU, 2014).
Only 43% of referred individuals accepted services despite the high rat of response by service providers (ASU, 2014). The real problem may rest in the fact that clients are unable to obtain services in a fast enough manner as most had to wait for provider services an average of 17 days. As well, the total population of individuals engaged in services was 5,464 (ASU, 2014). Considering that this is a low number of substance abusers this shows the program to be inadequate at serving the population. Even more revealing is the evaluation of the program’s recovery rates:
A total of 2,815 individuals participated in a substance abuse assessment, 84.8% of whom reported use in the past 30 days (ASU, 2014).
The effectiveness of FIRST appears to be questionable considering that 84% of the abusers in the program continued using substances after 30 days. ASU discussed these issues in the its program evaluation and stated that the referral of services and the acceptance of services appears to be a difficult area of measure.
While 3,309 referrals were reported to have accepted services, in fact, it appears that 3,871 (the number of individuals reported to receive AFF services) accepted services, since individuals cannot receive services without providing a release of information and formally agreeing to services (ASU, 2014).
It appears that there are large holes in the reporting and that many people who were referred to services are either not getting the services are refusing them. Why this occurs may be due to inefficiencies in the programs referral process. This is indicative of many programs in the US in which resources are overtaxed and service routinely become unavailable despite continued referrals. What may be more disturbing is the fact that because FIRST maintains the require criteria for child services and goals as CB, funding continues to occur despite the fact that less than half of the people referred to services actually obtain them. FIRST is not alone in this problem, there are many programs funded by CB which have similar issues. The real issue may be that centralized funding of programs such as this lack the ability to provide substantive measures or goals for long term program success.
ASU. (2014). Arizona Families F.I.R.S.T. Program Annual Evalutation Report. (C. f. University, Producer, & Arizona State University ) Retrieved from Department of Child Safety
Children’s Bureau . (2017). State & Tribal Child and Family Services Plan. Retrieved from Children’s Bureau
FIRST. (2017). Arizona Families F.I.R.S.T. Retrieved from Arizona Department of Child Safety
Kalergis, K. I. (2009, August). A Passionate Practice Addressing the Needs of Commercially Sexually Exploited Teenagers. Journal of Women and Social Work, 24(3).
Vaillant, G. (1995). The natural history of alcoholism revisited. Cambridge, MA: Harvard.